At a Glance
Problem: Neck and shoulder pain following an accident, at times severe enough to interfere with sleep.
Treatment: Local neck and shoulder treatment initially reduced the broader pain, including symptoms in the front of the shoulder.
Key Change: When the remaining shoulder pain did not seem to respond to treatment that had helped before, treatment shifted to the cervical spine. The shoulder pain improved afterward, and later EMG testing identified involvement at C5–C7.
Outcome: Neck and shoulder symptoms became less limiting, and the patient gradually returned to more regular workouts..
Presentation
The patient developed neck and shoulder pain following an accident. Early in treatment, the pain involved a broad area of the neck and shoulder, including the front of the shoulder, upper trapezius, and posterior neck and shoulder.
The pain could be significant and at times interfered with sleep.
Examination found marked tension and tenderness through the neck and shoulder musculature, including the scalenes, levator scapulae, and posterior cervical muscles.
Early treatment focused on these symptomatic areas, and the patient began to improve.
Early Treatment
Initial treatment focused on the areas that were most painful and restricted.
Acupuncture, dry needling, electroacupuncture, and manual therapy were used through the neck and shoulder musculature, including the upper trapezius, levator scapulae, posterior cervical muscles, rotator cuff region, and anterior and lateral shoulder.
Additional acupuncture points were used to reduce overall muscular tension, calm the nervous system, and support recovery.
Over the next several weeks, this approach worked well. The broader neck and shoulder pain improved, and the pain in the front of the shoulder became less prominent.
As treatment progressed, the remaining pain was felt more through the upper trapezius, posterior shoulder, and deltoid region.
A Change in Direction
At a later visit, we treated the neck and shoulder using areas and acupuncture points that had previously reduced the patient’s pain.
Afterward, however, the patient was still experiencing significant pain around the upper trapezius and shoulder.
Because the treatment that had worked before did not seem to reduce his pain, we had to look elsewhere. During that same visit, we changed the approach.
At that point, we focused only on the cervical spine rather than treating the painful shoulder region again.
After the cervical treatment, the shoulder pain improved.
That response changed the direction of treatment. Although the patient continued to feel the pain primarily around the shoulder, the cervical region became a greater focus in subsequent visits.
The Cervical Spine Becomes a Greater Focus
Over the following several weeks, treatment continued to place greater emphasis on the cervical spine while still addressing the neck and shoulder as needed.
The response became more consistent. The patient reported that the neck and shoulder were feeling better, and the shoulder was no longer interfering with sleep.
The possibility of a cervical or nerve-related component was discussed, and the patient later underwent nerve testing.
The patient later reported that EMG testing identified involvement at C5-C7, which was consistent with the cervical contribution we had begun to suspect clinically.
Outcome
As treatment continued, the neck and shoulder symptoms continued to improve.
The patient gradually returned to more regular exercise and became more consistent at the gym. Shoulder and neck symptoms became less limiting, allowing him to progressively return to his usual workouts.
Some clinical details have been generalized to protect patient privacy. Individual results vary.